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Unstuck Institute, Roberta Rothstein, LICSW,  Director
Helping you get Unstuck and Back on Track!
multicultural group of teens laughing
Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • New Client Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

New Client Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

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